Adverse events in health care: examining the second victim experience

[English]
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Abstract

Adverse events are a common occurrence in health care. While much attention has been paid to the impact of adverse events on patients and families, little is known about the experiences of health care providers as “second victims.” This study examines the experiences of second victims, using the example of one Canadian health region that had experienced a large-scale event that continues to shape how adverse events are understood and managed in that context. The methodology used is critical ethnography. The researcher uses her knowledge as an insider to health care organizational culture to explore the embodied and everyday experiences of health care providers. The study makes explicit the connections between culture and power to scrutinize the normative assumptions, values and beliefs that shape, and are shaped by, the experience of adverse events.
Staff feel powerless to speak up about adverse events; and by resisting the oppression that they fear will result if they were to speak out, they perpetuate the relations of power. Staff blame a constructed monolithic health care organization for the oppression, a story of responsibility and blame that is reinforced by the public via the media. Power is hidden and implicit in the system. Key findings are: (1) Health care providers involved in adverse events need to be given the opportunity to talk about their experience; (2) The best way to provide support is to recognize that support is needed quickly; and (3) In order for an organization to appropriately support the second victims of adverse events and their subsequent patients, a systems approach -- with attention to organizational culture in its relation to power -- is required.
The specific organizational features that shaped the experiences of health care providers in this study are not unique to the organization that was the site of the study. This study illustrates the magnitude of the trauma and the expanse of the possible experiences and helps us to understand more fully the second victim perspective and how a health care organization can mitigate the trauma to second victims.